The recommended treatment of mild asthma is regular maintenance inhaled corticosteroids (ICSs) and a short-acting β-agonist as a separate inhaler used when needed for symptom relief. However, the benefits of regular ICS use in actual clinical practice are limited by poor adherence and low prescription rates.
Image: Cross section of narrowing of bronchus, veins and arteries during asthma attack
An alternative strategy would be the symptom-driven (as-required or "prn") use of a combination ICS/short-acting β-agonist or ICS/long-acting β-agonist inhaler (formoterol) as a reliever rather than regular maintenance use. The rationale for this approach is to titrate both the ICS and β-agonist dose according to need. This may enhance ICS use in otherwise poorly adherent patients who over rely on their reliever β-agonist inhaler alone.
There is evidence to suggest that this regimen has advantages over regular ICS therapy for the treatment of mild asthma.
Combination corticosteroid/β-agonist inhaler as reliever therapy: A solution for intermittent and mild asthma? Beasley R, Weatherall M, Shirtcliffe P, Hancox R, Reddel HK. J Allergy Clin Immunol. 2014 Jan;133(1):39-41. doi: 10.1016/j.jaci.2013.10.053.